Will Utah's lawmakers take action on Medicaid this session?

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With time running out in the 2014 session, Senate Majority Leader Ralph Okerlund says it is likely that the Legislature will not act on Medicaid expansion or any of the various health reform proposals on the table.

"It's definitely getting less and less likely as we get closer to the end of the session that [senators] end up taking a firm position," Okerlund, R-Monroe, said in an interview.

He said that, with time running out and details of all three plans still fuzzy, it might make more sense to let the governor explore what waivers might be available for the state to implement a customized health care plan for Utah's poor and "then we may end up coming back in special session and putting it all together."

But Gov. Gary Herbert expressed no doubt that he will come to an agreement with the House and Senate on how to cover as many as 111,000 low-income Utahns.

"I think there will be a plan. The question will be: How specific is the plan? Maybe it's a plan to have a plan. We have eight days yet to go here [in the session]," Herbert said. "We're working vigorously."

The governor said he anticipates the Legislature will give him "clear direction and consensus" on the best policy, a framework within which he can negotiate potential waivers with the administration of President Barack Obama. Then he would return to the Legislature in a special session for approval of the specifics.

"I would like to have them give me that authority, that blessing, that 'Go get 'em, cowboy,' kind of approach and see what we can do back in Washington," Herbert said.

Despite Herbert's optimism, House Speaker Becky Lockhart acknowledged that there is "quite a gap" between the trio of competing proposals put forward by House Republican leaders, the governor and Sen. Brian Shiozawa, R-Cottonwood Heights.

The House would reject $524 million of federal Medicaid funds and instead use $35 million in state money  matched with about $80 million of federal dollars  to extend some health care to an unknown number of the poorest Utahns.

Herbert has proposed taking $258 million in federal funds and seeking a federal waiver allowing the state to provide subsidies so that individuals making up to $15,500 could buy private insurance.

Shiozawa's plan is similar, seeking the federal money to provide insurance subsidies to those below the federal poverty line of $11,670 in income annually.

"There is a significant difference between what the governor is proposing and what the House bill proposes, and then there are some in-betweens with the proposal coming out of the Senate," said Lockhart. "So there is a wide divide, which isn't unusual for the legislative branch and executive branch to have differing opinions."

But there are details that could trip up all three of the plans. Both the governor's proposal and Shiozawa's bill would require a federal waiver  and it is uncertain that either, especially Shiozawa's, could qualify.

Michael Hales, state Medicaid director, said it's possible a waiver could be approved in as little as three months, but a target of six months is more likely.

The House GOP proposal would also need an expansion of an existing waiver.

Herbert met with Republican senators in their closed caucus Tuesday to pitch his health-care plan, while Lt. Gov. Spencer Cox handled the salesmanship in the open meeting of House Republicans, seeking common ground among a seemingly skeptical audience.

"We need to start at square one, and square one is we all hate Obamacare," said Cox. "We agree with all of you that this is one of the worst iterations of law to come forward."

Republicans in both the House and Senate discussed the governor's proposal in closed meetings after the briefing, but neither has taken any position endorsing any of proposals before them.

Democrats in both the House and Senate months ago embraced full expansion under Obamacare, covering all 111,000 Utahns through the Medicaid program, as the Affordable Care Act envisioned.

Rep. Brad Wilson, R-Kaysville, urged his House colleagues to be cautious and take their time, arguing if the state extends health coverage to the poor, pulling that back in two or three years  as all three plans would allow  is politically untenable.

"This seems to be an irreversible decision. Once we make it we can't turn back," he said, so it is wise "to make irreversible decisions slowly. I think we should do that here and I think we should move slower."